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<meta name="description" content="同样还是读书的总结，讨论拔牙钳和拔牙挺。 拔牙钳(Extraction Forceps）简单的拔牙由拔牙钳和牙挺的辅助来完成。每个拔牙钳分两个部分，两部分联合在一起形成一个器械。拔牙钳的基本组成部分是柄，在关节铰链的上方，以及喙，在关节铰链的下方。用手握住器械的柄一端，在拔牙的时候向上施加压力。喙的一端是器械的工作端，在牙颈部夹持住牙齿，使牙齿脱离牙槽窝。由于牙齿的解剖形态各异，拔牙钳有各种特殊的">
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<meta property="og:description" content="同样还是读书的总结，讨论拔牙钳和拔牙挺。 拔牙钳(Extraction Forceps）简单的拔牙由拔牙钳和牙挺的辅助来完成。每个拔牙钳分两个部分，两部分联合在一起形成一个器械。拔牙钳的基本组成部分是柄，在关节铰链的上方，以及喙，在关节铰链的下方。用手握住器械的柄一端，在拔牙的时候向上施加压力。喙的一端是器械的工作端，在牙颈部夹持住牙齿，使牙齿脱离牙槽窝。由于牙齿的解剖形态各异，拔牙钳有各种特殊的">
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        <p>同样还是读书的总结，讨论拔牙钳和拔牙挺。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/01.jpg"></p>
<p>拔牙钳(Extraction Forceps）<br>简单的拔牙由拔牙钳和牙挺的辅助来完成。每个拔牙钳分两个部分，两部分联合在一起形成一个器械。拔牙钳的基本组成部分是柄，在关节铰链的上方，以及喙，在关节铰链的下方。用手握住器械的柄一端，在拔牙的时候向上施加压力。喙的一端是器械的工作端，在牙颈部夹持住牙齿，使牙齿脱离牙槽窝。由于牙齿的解剖形态各异，拔牙钳有各种特殊的设计。主要根据拔牙钳柄的大小，形状，以及喙的形状，来区分。<br>上颌前牙（13-23）<br>喙和柄在同一水平，喙是凹面形的，没有突起。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/02.jpg"><br>上颌通用牙钳或150号拔牙钳(No. 150 Forceps）<br>上颌前磨牙拔牙钳有一个轻微的弯曲形状，看起来像“S”形。把拔牙钳拿在手上，柄的弯曲的部分的凹面对着手掌，喙的凹面部分就转向上面。牙钳的喙端是凹形的而且没有突起(pointed)。这种牙挺也可以用来拔上颌的六颗前牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/03.jpg"><br>上颌磨牙钳（用于第一第二磨牙）<br>有两种，分左右的。像前磨牙钳一样，它们也是有一个“S”形的弧度。牙钳喙缘的颊侧设计有一个突起，以适合于颊侧两个牙根之间的根分叉区。而腭侧的喙缘是凹形的，适应于腭侧突起的颈部。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/04.jpg"><br>上颌第三磨牙牙钳<br>就像前面提到的有一个弯曲的弧形，是最长的牙钳，原因是第三磨牙比较靠后。因为第三磨牙的牙齿形态多变，所以喙缘是平滑的凹形（没有尖的突起），因此它也是不分左右，都可以用的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/05.jpg"><br>上颌牛角磨牙钳（Maxillary cowhorn molar forceps）<br>是上颌磨牙钳的一个变异。其喙缘是尖的，适合于进入根分叉区域。适合于用来拔残冠，如果用来拔完整的牙齿，有可能会使颊侧牙槽骨损伤。因为力量太大。（原来牛角钳是用来拔残冠的，我以前不知道，拔残冠要么就用挺，要么用普通牙钳，结果往往一夹就碎，变成残根，增加了拔牙的难度。书里没有图，我从网上找了一张。）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/06.jpg"><br>上颌根尖钳<br>牙钳的柄是直的，而会使窄的而且是有角度的。喙缘是凹形的而且没有尖。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/07.jpg"><br>用于下颌牙的牙钳或下颌通用牙钳或151号牙钳（Mandibular Forceps for Anterior Teeth and Premolars or Mandibular Universal Forceps or No. 151 Force)<br>和上颌牙钳不同的是，下颌牙钳的喙和柄的方向是一致的，形成一个拱形。当握住钳柄的时候，柄的拱形的凹面对着手掌，而喙缘则向下对着牙齿。喙缘是凹形光滑的，没有突起。151号牙钳用于拔除下前牙和前磨牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/08.jpg"><br>下颌磨牙钳<br>可以用于两边牙齿的拔除，有一个直的柄和一个与柄近似垂直的喙。喙的两部分都有尖的突起，以适应于颊舌侧的根分叉。该牙钳用于拔除下颌两侧第一第二磨牙。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/09.jpg"><br>下颌第三磨牙牙钳<br>也有直的柄，喙跟第一第二磨牙钳一样，是垂直于柄的。它的喙要比第一二磨牙钳长一些，因为第三磨牙的位置较深。由于第三磨牙变异较大，常没有牙根分叉，所以喙缘没有突起。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/10.jpg"><br>下颌磨牙牛角钳（Mandibular cowhorn molar forceps）<br>23号牙钳，是下颌磨牙钳的一个变异。喙是半圆形的，并且有一个较尖的突起末端，于是它们可以进入颊舌侧的根分叉区，牢固的抓住牙齿。当术者把牙钳放置到根分叉区域，捏紧手柄，用小的颊舌向的运动，使患牙脱离牙槽窝。牛角钳也可以用于下颌后牙的分根（sectioning roots of posterior teeth），当它们的牙冠已经严重损坏时。在抓牢了牙齿以后，牙齿很容易使用因为在根分叉区域施加压力而分开。(干嘛不用快机磨？）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/11.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/12.jpg"><br>垂直铰链钳(Vertical Hinge Forceps）<br>这些英国式的(English-style？）牙钳跟之前的牙钳的不同之处在于它们的铰链是垂直方向的。它们的使用很有限，因为大量其它牙钳可以替代它们。如果牙槽骨不是很有弹性，它们会增加牙槽骨骨折的风险。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/13.jpg"><br>下颌根尖钳<br>柄是直的，喙是凹形的而且与柄垂直，末端非常窄，当牙钳闭合时适合于根尖。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/14.jpg"><br>以前对拔牙钳认识也比较模糊，上下当然分得清，但是前牙，前磨牙，以及前磨牙和磨牙往往弄混，还有方向的问题。看了书清晰了一些。我用思维导图总结了一下。当然主要还是要多拔就熟了。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/15.jpg"><br>拔牙挺(Elevators)<br>是拔牙钳之外最重要的拔牙器械。它由三部分组成：把手(handle，前面拔牙钳里的“柄”应该是把手），柄(shank），和刃(blade）。在口腔外科中通常由三种牙挺：直挺(straight elevator)、T形或横形把手挺（the pair of elevators with T-shaped or crossbar handles），以及双角挺（double-angled elevators）。<br>直挺<br>是最常用的。用来拔牙齿和牙根。上下颌通用。把手是梨形设计的，足够大，可以很舒适的用力。柄是窄的，较长，连接把手和刃。刃有两种表面：即凸面和凹面。凹面置于颊侧，可以垂直于牙面或者有一定角度，并且始终与要拔的牙齿接触。用主力手（左撇子用左手的意思吧？）示指(index finger)沿着刃，接近其末端。刃的末端暴露，放置在牙槽骨和要拔的牙齿之间。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/16.jpg"><br>T形或横形把手挺对(Pair of Elevators with T-shaped or Crossbar Handles）<br>只用在下颌，用来拔除牙根或磨牙，在其它牙根已经用直挺拔除以后使用。柄在把手的中间与把手连接。柄和刃的连接是有角度的，刃的末端是三角形的。刃有两个方向，根据要拔的牙根的方向来选择。一个用来拔除近中根，另一个用来拔除远中根。角度记录挺(Angled Seldin elevators)是它的一个变异。<br>在特定的情况下，T形挺可以用来拔除完整的下颌第三磨牙。挺的尖端放入患牙的颊侧根分叉区域，用外斜嵴(external oblique ridge）来做支点。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/17.jpg"><br>双角挺对(Pair of Double-Angled Elevators）<br>主要用来拔上下颌的根尖，对拔上颌第三磨牙同样非常有用。把手与直挺相似，柄有两个角度，于是器械可以进入牙槽窝，两个挺有相反的方向。挺刃有凹形和凸形两个面，以一个尖锐的突起结束。也有窄的挺刃和尖锐的末端的双角挺，可以容易的拔除小的破碎的牙根。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/18.jpg"><br>其它类型的拔牙挺<br>直雄普雷挺(Straight Chompret Elevator)：不知道怎么翻译了。窄的挺刃说明这个器械可以像直挺一样使用。仅用在直挺的宽度太宽，阻止其插入到被拔的牙齿的正确的位置的时候。<br>弯雄普雷挺，有狭窄挺刃的双角挺等，都是根据情况使用。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/19.jpg"><br>用于拔除根尖的特殊器械<br>用来拔除牙槽嵴以下的残根。螺旋的末端插入要拔牙齿的牙槽骨中，在用螺丝将器械固定在残根的根管内，用牵引力拔除残根。（好多人用挫之类的拔残根，也是这个原理吧。)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/20.jpg"><br> 根尖搔刮器(Periapical Curettes）<br>双侧有角度的末端，汤匙样的器械。用来进入骨缺损和拔牙创，主要用来去除肉芽组织，小的囊肿，骨片，异物等。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0009-bycyqx/21.jpg"><br>植皮刀(Desmotomes)<br>用来切断软组织的结缔，有直的和弯的。直的用在上颌前牙区，弯的用在用于其余区域。<br>（没讲牙挺的型号，怎么用挺。也许后面拔牙的时候会讲。见得最多的还是直挺，其它的就用过T形挺（也叫三角挺），用来拔下颌8。其它器械用得比较少。）</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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